This isn't a mid-life crisis. It's a teen crisis, and it's getting worse.
According to new preliminary data from the National Youth Tobacco Survey, over one in four high schoolers (27.5% according to the American Lung Association) are current e-cigarettes users (defined as having used e-cigarettes in the previous 30 days). That's a significant jump from the one in five (20.8%) in 2018 that was reported in the Morbidity and Mortality Weekly Report (MMWR). Lisette Voytko first reported these numbers for Forbes and wrote that "Youth e-cigarette usage has surged in the past two years—in 2017, the CDC reported 11.7% of teens were using the devices."
This teen crisis could become a mid-life crisis for some teens if they go on to die early from vaping-associated lung disease. The CDC has confirmed that six people so far have passed away due to lung damage believed to be related to e-cigarette use, otherwise known as vaping. There's been over 450 reported cases in 33 states and one U.S. territory of severe lung problems that appear to be associated with vaping. It still isn't clear what about vaping may be causing this lung injury and whether certain brands have specific ingredients that are the culprits. Nevertheless, these cases highlight the lack of regulation and dearth of rigorous scientific studies when it comes to vaping. Moreover, the nicotine in e-liquids has the potential of being addictive and affecting brain development in children. Take a deep breath, America, we've got another full blown crisis.
This crisis prompted two separate announcements on Wednesday, one from Bloomberg Philanthropies and the other from the U.S. Food and Drug Administration (FDA). Both centered around flavored e-cigarettes.
Bloomberg Philanthropies, the philanthropic organization founded by former New York City Mayor Michael Bloomberg, announced the launch of “Protect Kids: Fight Flavored E-Cigarettes.” This is a $160 million, three-year initiative that aims to ban all flavored e-cigarettes and the marketing of e-cigarette products to kids.
Why ban flavored e-cigarettes? Flavored e-liquids, which are used in vaping devices, can make e-cigarettes seem more like candy. Take a look at some of the names of e-liquids that are used to vape: Alien Piss, Unicorn Vomit, and Smurf's Blood. Do these sound like products being marketed exclusively to adults? When products sound like they belong in a cartoon hospital emergency room, you've gotta wonder whom the target audience may be. If vaping were just being marketed to help people quit tobacco use, why the flavors? Why not just make it taste like tobacco?
Pair this with the mounting evidence that e-cigarettes are being marketed to kids. For example, according to the CDC, "more than half of high school students (about 8 million) saw e-cigarette ads in retail stores, and more than 6 million saw them on the Internet," and "more than half of middle school students (6 million) saw e-cigarettes ads in retail stores, and more than 4 million saw them on the Internet." On Monday, the FDA sent a letter to e-cigarette manufacturer JUUL warning them about their marketing practices, which have included presentations to youth at schools. Yes, presentations at schools.
“E-cigarette companies and the tobacco companies that back them are preying on America’s youth," said Bloomberg in a statement. "They are using the same marketing tactics that once lured kids to cigarettes, and the result is an epidemic that is spiraling out of control and putting kids in danger of addiction and serious health problems.” Bloomberg is also the World Health Organization (WHO) Global Ambassador for Noncommunicable Diseases.
The Campaign for Tobacco-Free Kids will lead this initiative and partner with other organizations and community groups to advocate for new measures to counter the teen vaping crisis. "We are deeply honored to partner with Bloomberg Philanthropies on this initiative,” said Matthew L. Myers, the President of the Campaign for Tobacco-Free Kids, in a statement. “Tobacco remains the number one cause of preventable death in the United States. This game-changing investment will provide critical resources to help the public health community stand up against Juul and other e-cigarette companies that peddle e-cigarettes to our kids and ensure that we don’t lose another generation of kids to nicotine addiction.”
As part of this initiative, the CDC Foundation will collect and analyze data on e-cigarette retail sales as well as teen use of e-cigarettes and attitudes about the crisis. E-cigarettes and marketing practices have spread relatively unfettered so quickly, outpacing scientific studies and the establishment of tracking and monitoring systems and data collection. Without enough data, it's difficult to understand the real extent of this crisis.
The FDA announcement did not indicate any specific new policies but said that "the FDA intends to finalize a compliance policy in the coming weeks that would prioritize the agency’s enforcement of the premarket authorization requirements for non-tobacco-flavored e-cigarettes, including mint and menthol, clearing the market of unauthorized, non-tobacco-flavored e-cigarette products." In other words, this was an announcement that there will be a future announcement of a plan to do something.
The announcement did mention President Donald Trump's name six times, including once in the title. On Wednesday, Trump made some comments about the teen vaping crisis, as shown on this ABC News segment:
As you can see, Trump gave reasons for First Lady Melania Trump being interested in combating the teen vaping crisis by saying, "That's how the First Lady got involved. She's got a son, together, that's a beautiful young man, and she feels very very strongly about it." The "it" presumably refers to the First Lady's interest in combating the crisis.
Bloomberg responded to the FDA announcement with the following statement:
The FDA's announcement that it will clear flavored e-cigarettes from the market' is the right one, but words are not enough. This decision is long overdue - the timeline for action is yesterday, not tomorrow. The agency must now move quickly to adopt a flavor ban that is comprehensive and that takes effect immediately. And it's up to us, the public, to hold them accountable – and I intend to do exactly that.
Indeed, with over a quarter of high schoolers and over one in 10 middle schoolers (in 2018 based on the MMWR publication) using e-cigarettes, the Unicorn Vomit has already left the barn, so to speak. This is already a genuine teen crisis that requires swift action. The frequently-used argument for vaping is that it can help people quit tobacco use. However, as the Mayo Clinic indicates, there isn't yet enough scientific evidence supporting this argument. More research is necessary before such claims can be substantiated. Plus, there are a number of other methods to help quit tobacco use, and tobacco-use worldwide was already trending downwards before vaping became popular.
Regardless of whether vaping eventually proves to be an effective way to decrease tobacco use, there is really no reason why e-cigarettes should be marketed to kids in any way. It's better to replace smokers with non-smokers rather than create a whole new generation of vapers. Stay tuned for what the FDA may announce next.
